|
Donald A. Mahler, MD, FCCP1, 2 Frank Cerasoli, PhD3 Lindsay Della, PhD4 Mark Rudzinski, MBA5
Author Affiliations
-
Emeritus Professor of Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire
- Valley Regional Hospital, Claremont, New Hampshire
- Medical Dynamics, New York, New York
- University of Louisville, Louisville, Kentucky
- Rockpile Strategies LLC, LaGrange, Illinois
Address correspondence to:
Donald A. Mahler, MD
Valley Regional Hospital
243 Elm Street
Claremont, NH 03743
Phone: 603 277-0383
Email: mahlerdonald@gmail.com
Abstract
Background: Little is known about patients’ use of the internet to search for information about chronic obstructive pulmonary disease (COPD) and their perspectives on disease content on websites.
Objectives: Todetermine the interests and behavior of patients with COPD who search the internet for disease information and to assess their perspectives about 2 COPD educational websites.
Methods: Individuals with COPD who had registered for a consumer panel were invited electronically to participate in a survey which included general use of the internet, online health behaviors about COPD, and assessment of 2COPD educational websites.
Results: A total of 445 respondents completed the survey in 23 ± 12 minutes (72% response rate). A total of 95% reported that physicians were the primary source of information about COPD followed by internet searches about the disease (76%). The 3 major information priorities were “symptom control” (82%), “how COPD is affecting my body” (60%), and “treatments that might work better for me” (59%). Overall ratings (range, 1 – 10) were 7.4 ± 1.5 for the American Lung Association and 6.8 ±1.8 for the COPD Foundation websites. Ratings by respondents were higher for all 5 impression attributes and for 8 of 9 content attributes on the American Lung Association website compared with the COPD Foundation website.
Conclusions: This report describes, for the first time, information priorities of patients with COPD about their disease and their assessment of 2 educational websites. Our survey results can be used by health care professionals to recommend online resources to their patients.
Citation
Citation: Mahler DA, Cerasoli F, Della L, Rudzinski M. Internet health behaviors of patients with chronic obstructive pulmonary disease and assessment of two disease websites. Chronic Obstr Pulm Dis. 2018; 5(3): 158-166. doi: http://dx.doi.org/10.15326/jcopdf.5.3.2017.0173
|
Erin R. Narewski, DO1 Amanda L. Blackford, ScM2 Matthew R. Lammi, MD3 Anne L. Fuhlbrigge, MD, MPH4 Xavier Soler, MD, PhD5 Richard Albert, MD6 Gerard J. Criner, MD1; for the Long-Term Oxygen Treatment Trial Research Group7
Author Affiliations
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
- Division of Biostatistics and Bioinformatics, Bloomberg School of Health, Johns Hopkins University, Baltimore, Maryland
- Division of Pulmonary and Critical Care Medicine, School of Medicine, Louisiana State University, New Orleans
- Channing Laboratory, Brigham and Women’s Hospital and Division of Pulmonary and Critical Care Medicine, Harvard Medical School, Boston, Massachusetts
- Division of Pulmonary and Critical Care Medicine, School of Medicine, University of California- San Diego
- Division of Pulmonary and Critical Care Medicine, School of Medicine, University of Colorado, Denver
- Members of the LOTT Research Group and their affiliations are listed in the Acknowledgements section of this article.
Address correspondence to:
Erin R. Narewski, DO
Department of Thoracic Medicine and Surgery
Lewis Katz School of Medicine
Temple University
3401 North Broad Street
Philadelphia, PA 19140
Erin.Narewski@tuhs.temple.edu
Abstract
Background: Chronic obstructive pulmonary disease (COPD) patients enrolled into the Long-term Oxygen Treatment Trial had hypoxemia at rest, hypoxemia on exertion, or hypoxemia both at rest and on exertion. We hypothesized that patients with different patterns of hypoxemia may have significant differences in clinical features.
Methods: All patients had COPD and oxygen saturation measured by pulse oximetry (blood oxygenation [SpO2]) at rest and during the 6-minute walk test (6MWT). Hypoxemia at rest was defined as resting SpO2 between 89-93%. SpO2 < 90% for at least 10 seconds and ³ 80% for at least 5 minutes during ambulation characterized hypoxemia on exertion. Severe exercise hypoxemia (< 80% for > 1 minute) was exclusionary.
Results: Of 738 patients studied, 133 (18.0%) had mild-moderate hypoxemia at rest only, 319 (43.2%) had hypoxemia on exertion only, and 286 (38.8%) had hypoxemia at both rest and exertion. Patients with hypoxemia at rest only were more likely to be current smokers, had higher body mass index (BMI) and a higher incidence of self-reported diabetes. Patients with hypoxemia on exertion only were more severely obstructed compared to the other groups. General and disease-specific quality of life scores were similarly impaired in all groups. Quality of well-being scores were more impaired in those with hypoxemia at rest only.
Conclusions: COPD patients with mild-moderate hypoxemia have distinct clinical characteristics based on the pattern of oxygen desaturation at rest and with exertion.
Citation
Citation: Narewski ER, Blackford AL, Lammi MR, et al; for the Long-term Oxygen Treatment Trial Research Group. Clinical differences in COPD patients with variable patterns of hypoxemia. Chronic Obstr Pulm Dis. 2018; 5(3): 167-176. doi: http://dx.doi.org/10.15326/jcopdf.5.3.2017.0175
|
A. James Mamary, MD1 Jeffery I. Stewart, MD1 Gregory L. Kinney, PhD2 John E. Hokanson, PhD2 Kartik Shenoy, MD1 Mark T. Dransfield, MD3 Marilyn G. Foreman, MD, MS4 Gwendolyn B. Vance, RN1 Gerard J. Criner, MD1 for the COPDGene® Investigators
Author Affiliations
- Department of Thoracic Medicine and Surgery, Lewis Katz School of Medicine, Temple University Health System, Philadelphia, Pennsylvania
- Department of Epidemiology, Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, Aurora
- Division of Pulmonary, Allergy and Critical Care Medicine, University of Alabama, Birmingham
- Division of Pulmonary and Critical Care Medicine, Morehouse School of Medicine, Atlanta, Georgia
Address correspondence to:
A. James Mamary, MD
Temple Lung Center 745
Parkinson Pavilion 3401
North Broad Street Philadelphia Pa, 19140
Phone: 215-707-3332
Email: albert.mamary@tuhs.temple.edu
Abstract
The COPD Genetic Epidemiology (COPDGene®) study provides a rich cross-sectional dataset of patients with substantial tobacco smoke exposure, varied by race, gender, chronic obstructive pulmonary disease (COPD) diagnosis, and disease. We aimed to determine the influence of race, gender and Global initiative for chronic Obstructive Lung Disease (GOLD) stage on prevalence of prior COPD diagnosis at COPDGene® enrollment. Data from the complete phase 1 cohort of 10,192 participants were analyzed. Participants were non-Hispanic white and African-American, ≥45 years of age with a minimum of 10 pack years of cigarette smoking. Characterization upon enrollment included spirometry, demographics and history of COPD diagnosis determined by questionnaire. We evaluated the effects of race and gender on the likelihood of prior diagnosis of COPD and the interaction of race and GOLD stage, and gender and GOLD stage, as determined at study enrollment, on likelihood of prior diagnosis of COPD. We evaluated the 3-way interaction of race, gender and GOLD stage on prior diagnosis. African-Americans had higher odds of not having a prior COPD diagnosis at all GOLD stages of airflow obstruction versus non-Hispanic whites (p<0.0001). Women had higher odds of having a prior COPD diagnosis at all GOLD stages versus men (p<0.0001). Three-way interaction of race, gender and GOLD stage was not significant. African-Americans were less likely to have prior COPD regardless of the severity of airflow obstruction determined at study enrollment. Women were more likely to have a prior COPD diagnosis regardless of the severity of measured airflow obstruction. Race and gender are associated with significant disparities in COPD diagnosis.
Citation
Citation: Mamary AJ, Stewart JI, Kinney GL, et al for the COPDGene investigators. Race and gender disparities are evident in COPD underdiagnoses across all severities of measured airflow obstruction. Chronic Obstr Pulm Dis. 2018; 5(3): 177-184. doi: http://dx.doi.org/10.15326/jcopdf.5.3.2017.0145
|
Glenda Euceda, MD1 Wing-Tai Kong, MD1 Amber Kapoor, MPH2 Patricia Dilauro, RN, RRT3 Rahila Ogunnaike, MD1 John Chronakos, MD3
Author Affiliations
- Department of Internal Medicine, Danbury Hospital, Western Connecticut Health Network, Danbury
- Department of Research & Innovation, Danbury Hospital, Western Connecticut Health Network, Danbury
- Section of Pulmonary Medicine, Department of Internal Medicine, Danbury Hospital, Western Connecticut Health Network, Danbury
Address correspondence to:
John Chronakos, MD
33 Germantown Road
Danbury, CT 06810
E-mail: john.chronakos@gmail.com
Phone: (203)739-6805
Abstract
Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is one of the leading causes of hospitalization in the United States. Prior investigations suggest clinical and physiological parameters are important determinants for AECOPD readmissions. Strategies aimed at addressing these factors have not resulted in a major reduction of readmissions. We compared patients readmitted after an index AECOPD admission with non-readmitted patients. Patients’ age, gender, body mass index, comorbidities (obstructive sleep apnea, chronic hypercapnia, congestive heart failure, lung cancer, pulmonary arterial hypertension, pneumonia, interstitial lung disease, atrial fibrillation, musculoskeletal disorders, cognitive disorders, and anxiety disorders), substance abuse and smoking status were assessed. Some 272 patients were included: 20 patients were readmitted within 30 days of their index hospitalization; 252 patients were not readmitted within 30 days of their index admission. Readmitted patients were significantly more likely to have pneumonia than non-readmitted patients (30.0% versus 13.1%, p<0.05). No statistically significant difference was seen with respect to other clinical comorbidities. Patients readmitted within 30 days were significantly more likely than non-readmitted patients to have safety issues at home (80.0% versus. 39.3%, p<0.001), anxiety (60.0% versus 29.8%, p<0.01), and lack of transportation (35.0% versus 15.5%, p<0.05). Implementation of a comprehensive care management program (CCMP) was associated with a reduction in readmissions from 21.5% to 13.6% (p<0.01, 95% confidence interval [CI] 2.08-12.45). A CCMP can reduce readmissions through attention to social variables, optimization of in-hospital care, improved coordination of pre- and post-discharge, a system to better identify problems after discharge, and an office setup that accommodates same-day visits.
Citation
Citation: Euceda G, Kong W-T, Kapoor A, Dilauro P, Ogunnaike R, Chronakos J. The effects of a comprehensive care management program on readmission rates after acute exacerbation of COPD at a community-based academic hospital. Chronic Obstr Pulm Dis. 2018; 5(3): 185-192. doi: http://dx.doi.org/10.15326/jcopdf.5.3.2017.0177
|
Gary T. Ferguson, MD1 Edward M. Kerwin, MD2 James F. Donohue, MD3 Vaidyanathan Ganapathy, PhD4 Robert L. Tosiello, MS4 Vamsi K. Bollu, PhD5 Krithika Rajagopalan, PhD4
Author Affiliations
- Pulmonary Research Institute of Southeast Michigan, Farmington Hills
- Clinical Research Institute of Southern Oregon, PC, Medford
- University of North Carolina School of Medicine, Chapel Hill
- Sunovion Pharmaceuticals Inc., Marlborough, Massachusetts
- Abilytic, Inc., Shrewsbury, Massachusetts
Address correspondence to:
Gary T. Ferguson, MD
Pulmonary Research Institute of Southeast Michigan
29255 West 10 Mile Road, Suite A
Farmington Hills, MI 48336
Tel: (248) 478-6561
Fax: (248) 478-6908
Email: garytferguson@msn.com
Abstract
Background: Symptoms of chronic obstructive pulmonary disease (COPD) may diminish patients’ health-related quality of life (HRQoL). We report effects of Longhala™ Magnair™ (glycopyrrolate) Inhalation Solution, a drug/device combination of the long-acting antimuscarinic glycopyrrolate administered using the eFlow® closed system (eFlow CS) nebulizer, on HRQoL from the Glycopyrrolate for Obstructive Lung Disease Via Electronic Nebulizer (GOLDEN) clinical studies.
Methods: Data consisted of a pooled analysis of 2 phase 3, 12-week efficacy studies (GOLDEN-3 and -4) of glycopyrrolate/eFlow CS (25 or 50 mcg twice daily [BID]) versus placebo, and a 48-week, open-label safety study (GOLDEN-5) of glycopyrrolate/eFlow CS 50 mcg BID versus tiotropium 18 mcg once daily in patients with moderate to very severe COPD. Change from baseline in HRQoL was measured via the St George’s Respiratory Questionnaire (SGRQ). Results are provided as mean changes in SGRQ Total score and as response analysis (≥4-point improvement [responder], no change, and ≥4-point worsening in Total score) using analysis of covariance or logistic regression, as applicable.
Results: A total of 1293 patients were evaluated from GOLDEN-3 and -4 and 1086 from GOLDEN-5. Glycopyrrolate/eFlow CS significantly improved SGRQ Total and component scores. The percentage of SGRQ responders in pooled GOLDEN-3/4 was 46.8% for glycopyrrolate/eFlow CS 25 mcg, 41.7% for glycopyrrolate/eFlow CS 50 mcg, and 34.5% for placebo. SGRQ Total and component score improvements were similar between glycopyrrolate/eFlow CS and tiotropium in GOLDEN-5.
Conclusions: The drug/device combination of glycopyrrolate/eFlow CS significantly improved HRQoL, as measured by the SGRQ, offering a potential maintenance treatment option in patients with moderate to very severe COPD.
ClinicalTrials.gov: NCT02347761, NCT02347774, NCT02276222
Citation
Citation: Ferguson GT, Kerwin EM, Donohue JF, et al. Health-related quality of life improvements in moderate to very severe chronic obstructive pulmonary disease patients on nebulized glycopyrrolate: evidence from the GOLDEN studies. Chronic Obstr Pulm Dis. 2018; 5(3): 193-207. doi: http://dx.doi.org/10.15326/jcopdf.5.3.2017.0178
|
Denitza P. Blagev, MD1,2 Dave S. Collingridge, PhD1,3 Susan Rea, PhD3,4 Valerie G. Press, MD, MPH5 Matthew M. Churpek, MD, MPH, PhD5 Kyle Carey, MPH5 Richard A. Mularski, MD, MSHS, MCR6,7 Siyang Zeng, MS8,9 Mehrdad Arjomandi, MD8,9
Author Affiliations
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Intermountain Medical Center, Murray, Utah
- Division of Respiratory, Critical Care, and Sleep Medicine, Department of Medicine, University of Utah, Salt Lake City
- Office of Research, Intermountain Healthcare, Salt Lake City, Utah
- Homer Warner Center for Informatics Research, Murray, Utah
- Section of General Internal Medicine, Department of Medicine, University of Chicago Medicine, Chicago, Illinois
- Kaiser Permanente Center for Health Research – Northwest, Portland, Oregon
- Division of Pulmonary and Critical Care Medicine, Oregon Health and Science University, Portland
- Division of Pulmonary and Critical Care Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, California
- Division of Pulmonary, Critical Care Allergy, Immunology and Sleep Medicine, Department of Medicine, University of California, San Francisco
Abstract
Rationale: Although chronic obstructive pulmonary disease (COPD) exacerbation frequency is stable in research cohorts, whether severe COPD exacerbation frequency can be used to identify patients at high risk for future severe COPD exacerbations and/or mortality is unknown.
Methods: Severe COPD exacerbation frequency stability was determined in 3 distinct clinical cohorts. A total of 17,450 patients with COPD in Intermountain Healthcare were categorized based on the number of severe COPD exacerbations per year. We determined whether exacerbation frequency was stable and whether it predicted mortality. These findings were validated in 83,134 patients from the U.S. Veterans Affairs (VA) nationwide health care system and 3326 patients from the University of Chicago Medicine health system.
Results: In the Intermountain Healthcare cohort, the majority (84%, 14,706 patients) had no exacerbations in 2009 and were likely to remain non-exacerbators with a significantly lower 6-year mortality compared with frequent exacerbators (2 or more exacerbations per year) (25% versus 57%, p<0.001). Similar findings were noted in the VA health system and the University of Chicago Medicine health system. Non-exacerbators were likely to remain non-exacerbators with the lowest overall mortality. In all cohorts, frequent exacerbator was not a stable phenotype until patients had at least 2 consecutive years of frequent exacerbations. COPD exacerbation frequency predicted any cause mortality.
Conclusions: In clinical datasets across different organizations, severe COPD exacerbation frequency was stable after at least 2 consecutive years of frequent exacerbations. Thus, severe COPD exacerbation frequency identifies patients across a health care system at high risk for future COPD-related health care utilization and overall mortality.
Citation
Citation: Blagev DP, Collingridge DS, Rea S, et al. Stability of frequency of severe chronic obstructive pulmonary disease exacerbations and health care utilization in clinical populations. Chronic Obstr Pulm Dis. 2018; 5(3): 208-220. doi: http://dx.doi.org/10.15326/jcopdf.5.3.2017.0183
|
|